Alcohol Detox and Rehab Programs: What to Know
Everyone has different needs when it comes to treating alcohol use disorder (AUD), a condition that can be diagnosed when your pattern of alcohol use is problematic and causes significant distress. It can range from mild to severe, depending on how many symptoms you have. The care you’ll need depends in part on where you fall in that range.
Some people with AUD become dependent on alcohol and have withdrawal symptoms when they suddenly stop drinking. The effects of withdrawal on your body and mind can be uncomfortable and dangerous. That’s where detox comes in.
What Is Detox?
Detox alone isn’t treatment, but it’s the first step to getting better for people who are dependent on alcohol. Learn more: Why start with detox for alcohol recovery.
When someone with a dependence on alcohol suddenly stops drinking, usually within 6-24 hours after their last drink, they might develop withdrawal symptoms. This can start while they still have alcohol in their blood.
Withdrawal symptoms are mild for some but much more serious for others. You may have:
- Delirium tremens (DTs), a life-threatening issue that can make you restless, upset, and confused and cause fever, hallucinations, and seizures
- Hallucinations, when you see or hear things that aren’t there
- Problems sleeping
- Shakiness, especially in your hands
- Unstable changes in blood pressure and heart rate
- Nausea and vomiting
Do I Need a Detox Program?
If you need alcohol for your body to feel normal, then you likely need help. Getting through detox isn’t just a matter of willpower, and stopping “cold turkey” without at least medical help is never recommended. In some cases, withdrawal can put your life at risk. Even when it’s not as serious, it’s still a big challenge.
A program gives you support to guide you through the withdrawal. That often includes medicine to help ease symptoms as well as care for medical and mental health conditions.
Your symptoms may last a week or more, typically hitting their worst within 24-72 hours. You’re more likely to stick with a detox program when you have lots of help.
Symptoms of Alcohol Withdrawal
Alcohol withdrawal symptoms may include:2,3
- Rapid pulse.
- Vivid dreams or nightmares.
- Hand tremors.
- Strong cravings for alcohol.
- Appetite loss.
- Restlessness leading to purposeless movements such as pacing.
Alcohol withdrawal symptoms will usually develop within about 4–12 hours of a person’s last drink. Alcohol withdrawal tends to be the worst around the 2nd day and tends to decrease significantly in severity by the 4th or 5th day.2
The most severe form of alcohol withdrawal is delirium tremens, a very rare and potentially life-threatening occurrence that occurs only in about 3%–5% of those experiencing alcohol withdrawal.4 DTs can occur as early as 2 days into the detox process and can last up to 5 days.4 Symptoms of DTs include:3,4,5
- Racing pulse.
- High blood pressure.
- Sensitivity to light, sound, and touch.
- Extreme agitation, excitement, or fear.
- Profound confusion.
* Seizures may arise without other symptoms of delirium tremens.5 If seizures do occur, they generally happen with 1-2 days of the last drink. Should a second one come on, it will usually happens within 6 hours. Status epilepticus, a series of seizures that arise one after another, is a rare complication of alcohol withdrawal.
Risk Factors for Severe Alcohol Withdrawal
The severity of alcohol withdrawal can vary widely among individuals. Some people may not any experience many symptoms at all, while others may have a very significant, even life-threatening, withdrawal syndrome. Those who drink more tend to have more severe withdrawal.3
Withdrawal from alcohol may be worse for those who:2,3
- Have a history of very heavy alcohol use.
- Have had an alcohol use disorder for a long period of time.
- Are older.
- Have one or more comorbid medical illnesses.
- Are dependent on other depressant drugs (e.g., benzodiazepines).
- Have had alcohol withdrawal experiences in the past.
- Have a history of DTs.
- Have extreme cravings for alcohol.
- Have abnormal liver function.
You can contact your physician or doctor if you have concerns about experiencing severe alcohol withdrawal.
Why Get Help for Alcohol Withdrawal?
There are several benefits for getting professional help when you want to get sober:
- It can keep you safe. Alcohol withdrawal is not dangerous for everyone; however, it’s not always possible to predict who will suffer severe or life-threatening symptoms.3 Being in a medically monitored environment under 24/7 supervision can lend you the peace of mind of knowing any complications that arise will be managed.
- It may help you avoid relapse. Even symptoms that aren’t particularly dangerous can be challenging or uncomfortable to deal with alone and may lead you to relapse back to alcohol in an attempt to seek some relief. Comfort care and medications available in a medical detox program can ease your distress as you overcome your dependence on alcohol.3 Should you chose to detox in an inpatient program, you’ll have the added benefit of being in a safe, substance-free environment where you won’t have alcohol nearby.
- It can be an entry point to further treatment. Though it is a vital part of recovery from alcoholism, detox itself does not constitute a comprehensive course of treatment and does little to change long-term alcohol misuse; it only addresses physical alcohol dependence and not the psychosocial issues that contribute to a person’s alcohol misuse.6 However, entering a detox program often kicks off a larger course of treatment. 3
Are You Ready for Alcohol Detox?
Excessive alcohol use can take a significant toll on your health and your life. If you’re coming to terms with alcohol’s negative impact on your life, you may be feeling ready to enter detox and get sober.
A feeling of readiness can be a benefit to you as you begin the path to sobriety. Detox is increasingly viewed as an action that should be undertaken when the patient feels ready.7 Motivation to enter and complete the detox process can be an important source of determination when facing withdrawal symptoms.8
There are ways to foster your readiness for detox. Some types of therapy, such as motivational counseling, can help you increase your motivation and prepare you for the process.8 For example, in one form of motivational counseling, motivational enhancement therapy (MET), your therapist helps move you into the action stage of change wherein you develop an expectation of a positive outcome (begin believing that your life will be better after detox). Then, discussions about what to expect during detox and after take place. During these discussions, you and your therapist work together to make specific plans to support your treatment efforts and help you stay sober beyond detox.7 Other types of therapy designed to enhance a patient’s motivation for change, such as contingency management (which utilizes external rewards as a motivator for positive change) and motivational interviewing, are available and utilized at many treatment facilities.
It is important to know, however, that that you don’t always have to be 100% ready for treatment to be successful. The National Institute on Drug Abuse (NIDA) states that unwillingness to enter treatment doesn’t necessarily correlate with treatment failure. Those who enter treatment involuntarily, due to a court order or family pressure, often have similar rates of treatment success as those who enter rehab voluntarily.6
The Alcohol Detox Process
Detox from alcohol can occur on either an inpatient or outpatient basis; however, inpatient detox is frequently recommended for those at risk of severe withdrawal or with a history of experiencing severe withdrawal symptoms.1
The detox process begins with an assessment, which involves:3
- An examination of the severity of withdrawal symptoms.
- Evaluating for any medical or psychiatric conditions.
- Assessing the risk of medical complications during withdrawal.
After a thorough assessment, management of alcohol withdrawal can begin in earnest. The process should be tailored according to the assessment made and include care for comorbid issues as well as medical interventions to reduce the risk of serious problems.3
During detox from alcohol, medical supervision can be an important component of the process. Inpatient detox programs provide this supervision on a 24/7 basis, which can ease your mind and the mind of your loved ones as you go through what can be a physically demanding and sometimes dangerous process.
At Laguna, our medical staff monitors patients’ conditions 24/7. We utilize a technology called EarlySense, a noninvasive monitoring system that is attached to a patient’s bed that can provide an alert to staff when necessary, for example if a patient’s pulse changes significantly.
Medical withdrawal management may involve the use of certain medications to ease symptoms and prevent medical emergencies:1, 3
- Benzodiazepines may be used to alleviate withdrawal symptoms and to prevent the onset of seizures or DTs. Long-acting benzodiazepines such as Librium and Valium are safe and are effective in staving off rebound symptoms (such as seizures) that can sometimes occur near the end of the withdrawal period. These medications may be administered as needed and given in smaller and smaller doses until they are eventually discontinued.
- Anticonvulsants, such as carbamazepine, may also be used to relieve the symptoms of mild to moderate alcohol withdrawal.
- Beta blockers and alpha-adrenergic medications (e.g., clonidine) can be given to manage symptoms like high blood pressure and rapid heart rate.
- Antipsychotics may be used for those suffering from withdrawal delirium; however, doctors use these medications with caution because they can lower the seizure threshold, making seizures more likely.
- Relapse prevention medications such as naltrexone or Acamprosate may be given during the latter part of detox to discourage relapse once the patient leaves and to provide a bridge into ongoing treatment.
Many people have questions about what medications are used during withdrawal. Your treatment provider can help to address any concerns or questions you have about which medications are used during detox and why, as well as the appropriate course of treatment for you or your loved one.
Another important part of medical detox is continuous monitoring and reassessment. Because a patient’s condition can change quickly during alcohol withdrawal, medical detox providers perform periodic reassessments of the symptoms and the risk of complications along the way. 3
Adjustments to the withdrawal management process may be made as symptoms wax and wane.